The use of forearm free fillet flap in traumatic upper extremity amputations.
BACKGROUND
Complete traumatic upper extremity avulsions are an infrequent but devastating injury. These injuries are usually the result of massive blunt trauma to the upper limb. Intact issue from amputated or nonsalvageable limbs may be transferred for reconstruction of complex defects resulting from trauma when the indications for replantation are not met. This strategy allows preservation of stump length or coverage of exposed joints, and provides free flap harvest for reconstruction without additional donor-site morbidity.


METHODS
A retrospective review at São João Hospital was performed on seven patients who had undergone immediate reconstruction with forearm free fillet flaps between 1992 and 2007.


RESULTS
There were six men and one woman, with patient age ranging from 17 to 74 years (mean, 41 years). Amputation sites were at the humeral neck (n = 1), at the humeral shaft (n = 5), and below the elbow (n = 1). The area of the forearm free fillet flap skin paddle was 352.14 +/- 145.48 cm (mean +/- SD). The two major complications were the flap loss and the patient death on postoperative day 3 in other case. The postoperative course in the remaining five cases was uneventful with good healing of the wounds. Minor complications included two small residual defects treated by split-thickness skin grafting and one wound infection requiring drainage and revision.


CONCLUSIONS
The forearm free fillet flap harvested from the amputated limb provides reliable and robust tissue for reconstruction of large defects of the residual limb without additional donor-site morbidity. Microsurgical free fillet flap transfer to amputation sites is valuable for achieving wound closure, improving stump durability, and maximizing function via preservation of length.
Oliveira
Isabel C
IC
Department of Plastic Reconstructive Aesthetics Maxillofacial Surgery, Hospital de São João, Porto Medical School, Alameda Prof. Hernâni Monteiro, Porto, Portugal. isabel.oliveira.mail@gmail.com
Barbosa
Rui F
RF
Ferreira
Pedro C
PC
Silva
Pedro N
PN
Choupina
Miguel P
MP
Silva
Alvaro M
AM
Reis
Jorge C
JC
Amarante
José M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000672:Amputation Stumps / Q000601:surgery; D000673:Amputation, Traumatic / Q000601:surgery*; D005260:Female; D005542:Forearm / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D034941:Upper Extremity / Q000293:injuries* / Q000601:surgery*; D014945:Wound Healing; D055815:Young Adult